title: Feasibility and safety of minimized cardiopulmonary bypass in major aortic surgery.
abstract: OBJECTIVE
  Conventional cardiopulmonary bypass causes haemodilution and is a trigger of systemic inflammatory reactions, coagulopathy and organ failure. Miniaturized cardiopulmonary bypass has been proposed as a way to reduce these deleterious effects of conventional cardiopulmonary bypass and to promote a more physiological state. The use of miniaturized cardiopulmonary bypass has been reported in low-risk patients undergoing valve and coronary artery bypass graft (CABG) surgery. However, little is known about its application in major aortic surgery.
  
  
  METHODS
  From February 2007 to September 2010, 49 patients underwent major aortic surgery using the Hammersmith miniaturized cardiopulmonary bypass (ECCO, Sorin). Data were extracted from medical records to characterize preoperative comorbidities (EuroSCORE), perioperative complications and the use of blood products. The same data were collected and described for 328 consecutive patients having similar surgery with conventional cardiopulmonary bypass at the Bristol Heart Institute, our twinned centre, during the same period.
  
  
  RESULTS
  The miniaturized cardiopulmonary bypass group had a median EuroSCORE of 8 [inter-quartile range (IQR): 5-11], 13% had preoperative renal dysfunction and 20% of operations were classified as emergency or salvage. Thirty-day mortalities were 6.4; and 69, 67 and 74% had ≥ 1 unit of red cells, fresh frozen plasma (FFP) and platelets transfused, respectively. Eight percent of patients experienced a renal complication, and 8% a neurological complication. The conventional cardiopulmonary bypass group was similar, with a EuroSCORE of 8 (IQR: 6-10); 30-day mortalities were 9.4; and 68, 62 and 74% had ≥ 1 unit of red cells, FFP and platelets transfused, respectively. The proportions experiencing renal and neurological complications were 14 and 5%.
  
  
  CONCLUSIONS
  Our experience suggests that miniaturized cardiopulmonary bypass is safe and feasible for use in major aortic cardiac surgery. A randomized trial is needed to evaluate miniaturized cardiopulmonary bypass formally.
authors.affiliation: Department of Cardiac Surgery, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Aziz U
authors.initials: AU
authors.lastname: Momin
authors.forename: Mansour T A
authors.initials: MT
authors.lastname: Sharabiani
authors.forename: Emadin
authors.initials: E
authors.lastname: Kidher
authors.forename: Ali
authors.initials: A
authors.lastname: Najefi
authors.forename: John W
authors.initials: JW
authors.lastname: Mulholland
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.forename: Jon R
authors.initials: JR
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016022:Case-Control Studies; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: Cardiopulmonary bypass; Heart surgery; Major aortic surgery; Miniaturized cardiopulmonary bypass